✦ Living with covid-19

✦ Living with covid-19
Image: Vinnie Neuberg
Image for article titled ✦ Living with covid-19
Image: Vinnie Neuberg

Hi Quartz members,

We’ve all been calculating risk throughout the pandemic. And though vaccinated folks may feel the stakes are now lower since they’re less likely to get seriously ill from the virus, various factors, including new variants such as omicron, may complicate this calculus. Is it safe to attend a museum if they’re checking proof of vaccination at the door, but not enforcing a mask mandate? What about flying? What about parties, or gathering for the holidays?

As has been the case throughout the pandemic, everyone’s risk calculus will be different, and no activity is totally risk-free. But we have some advice from experts about how they’re thinking about risk, and what it will take to go back to “normal.”

Sizing up the situation

Humans assess risk in two main ways: emotionally and analytically. The emotional system tends to jump in and make snap judgments (that makes sense when you think about how humans evolved to need to run from predators), while the analytic system takes more time. People often use both when making a decision, but “if we think we can respond to complex situations the easy way—with our feelings—then we go that way,” Paul Slovic, a psychologist who studies risk, tells NatGeo.

The pandemic is almost perfectly designed to short wire both of those methods of assessment. Emotionally, we’re burnt out on pandemic fatigue—we’re tired of wearing masks, of asking someone if they’re vaccinated, of eating meals outside. We’re just ready for it to be over, and that frustration can get in the way of making logical decisions.

The facts, too, keep changing. While the main refrains of how to not get sick have held true throughout the pandemic, many of the details have shifted as researchers learned more about the virus. That can make it hard to know whether you’re acting in a way that is in line with your personal risk tolerance.

Adding other people to the mix makes it even harder. “I think most people feel burdened by making all the decisions surrounding covid and especially by navigating relationships with people who have different risk tolerance and values surrounding vaccination,” says Elizabeth Goldberg, an associate professor of emergency medicine at Brown University. “People have different perceptions of what is an acceptable risk and we live amongst many people who are immunocompromised or are not yet eligible for vaccination.”

Risk factors

There’s no one-size-fits-all way to assess your approach to covid-19. But here are some factors that may play a role in whether or not you choose to participate in a particular activity.

🦠  Your biology. Some factors that might make you more likely to contract serious illness, such as age and underlying medical conditions, have been known for much of the pandemic. If you’re older, say, you might choose to be more cautious. As scientists are learning more about how the virus affects the body, variants may change which biological factors make us susceptible.

🤔  Your circumstances. If you live with someone who is immunocompromised, or if you’re charged with caring for an elderly parent who is at higher risk, you may think extra hard about how much risk you (and they) are comfortable with, particularly if local transmission rates are high.

💉  Vaccination status. Got your booster yet? If so, you’re more likely to be protected against the omicron variant, which early data indicates is more transmissible. It’s worth considering whether you’ll be around a mix of vaccinated and unvaccinated people, even with masks on. “In terms of get togethers, the most dangerous combo is vaccinated and unvaccinated or of unknown status,” says Maureen Miller, an adjunct associate professor of epidemiology at Columbia’s Mailman School of Public Health, because unvaccinated people are more likely to introduce the virus, which could infect vaccinated people.

🏞️  Activity details. Is it outdoors or indoors? If indoors, how well ventilated is it? Will people be taking their masks off? Will three people be present, or 3,000? Different circumstances could present situations with a range of risk levels.

🧠  Your mental state. The pandemic has left so many of us feeling isolated and depressed; if you’re feeling low, an activity could help. It’s really essential to human beings to have connectedness,” Goldberg says. “If it is going to bring you joy or it’s essential for learning, health, or work, do it, but be smart about testing, vaccination, and other mitigation measures.” Fear and anxiety, too, are real factors that you should take into account, particularly because long covid is still poorly understood.

Omicron interlude

Though researchers are still working to learn more about omicron—how transmissible it is, how severe it is, how likely it is to reinfect people—overall, the experts we spoke with said omicron isn’t changing their risk calculus all that much; if anything, it’s making them a little more cautious.

“Until we have more information, the prudent thing for people to do is to say, ‘I have my delta calculus, I don’t know how to factor things in objectively to my omicron calculus, but I should be more careful because it could be more transmissible and vaccination less protective,’” says John Swartzberg, a professor emeritus at UC Berkeley’s School of Public Health.

What are we waiting for?

Back in August, right as the delta variant was emerging (as of mid-November it made up 99% of cases worldwide), I wrote about what it will take to end the pandemic:

  1. Vaccinate everyone
  2. Achieve herd immunity
  3. Stay ahead of variants
  4. Learn to live with covid-19

If you’ve gotten your vaccine and your booster, you’re doing everything you’re supposed to do. So why can’t you return to normal life quite yet?

“From a public health standpoint, [the pandemic] is over when we can prevent death and care for people in hospitals,” says Swartzberg. Miller even has a number: 10 cases per 100,000 people or less. “Very, very low levels of transmission,” she notes.

For the rest of us, we’re in a long, slow process of step 4: learning to live with covid. The pandemic will functionally end at different times for different individuals based on their risk assessment—a 25-year-old will be back to “normal” before a 70-year-old may be, for example. And there are things that may change that timeline, such as how long the vaccines grant us immunity or if new variants evade it. As long as there are still risks from the virus, such as long covid, Swartzberg questions whether we can say the pandemic will have actually ended.

Experts expect that we’ll never be fully rid of covid. But as more of the world gets vaccinated, the virus will present a lower risk, and we’ll learn to live with it.

Tools of the trade

The pandemic isn’t over yet. But our toolkit to manage it keeps growing.

Rapid tests. While at-home rapid tests work differently than the PCR-based covid test you might get at a hospital, they have the advantage of working quickly on the go. That’s particularly useful if you’re spending time with a high-risk individual or getting together in large groups (they were particularly popular over Thanksgiving in the US even though they are less available there than in European countries).

Masks. If in fact the omicron variant is more infectious (though not necessarily more severe) than earlier iterations of the virus, we fortunately know that masks really work. It’s even more important to use a good mask, like an N95, in indoor spaces; a surgical mask or anything with at least two layers is better than a cloth mask.

Oral treatments. Drugs that can reduce covid’s most severe symptoms are on their way. Late last month, Merck’s oral covid-19 treatment narrowly received emergency use authorization from the US Food and Drug Administration. Other pharma companies, such as Novartis and Pfizer, are working on similar drugs.

Even better vaccines. More, and potentially more effective, vaccines are in development.

Sound off

How much is covid-19 currently affecting your daily life?

I’m still living like it’s March 2020

I’m slowly learning to live with the virus

What virus?

In last week’s poll about AI without code, 38% of respondents said they were ready to team up with AI to get more done. We admire your optimism.

Have a great week,

—Alex Ossola, membership editor (still not comfortable going to a gym)

One 🤖 thing

Making decisions about covid risk doesn’t have to be based on your best guess: There are a number of online tools that can help you assess the risk of a given situation. Note that some or all of these calculators have not incorporated data based on new variants.

MyCOVIDRisk (Brown University)

COVID-19 Mortality Risk (Johns Hopkins University)

COVID-19 Event Risk Assessment Planning Tool (Georgia Tech)

COVID-19 Risk Calculator (Harvard T. H. Chan School of Public Health)

19 and Me (Mathematica)

microCOVID Project (independent)